Background Diagnosis of latent tuberculosis infection (LTBI) is a cornerstone of the health assessment of resettled high incidence populations, particularly in children. Two blood-based interferon g release assays (IGRAs), T-SPOT.TB and QFT-Gold in-tube (QFT-GIT), have greater sensitivity and specificity than the tuberculin skin test (TST), but their performance as screening tools for LTBI in children, especially refugee children, remains unclear. Methods 524 African and ethnic Burmese children, including 107 under 3 years of age, were prospectively enrolled in a comparison of the T-SPOT.TB and QFT-GIT. The TST was also performed in 342 of the children. Results The T-SPOT.TB and QFT-GIT had similar rates of positivity (8% and 10%, respectively) and showed good concordance when both tests gave definitive results (k¼0.78; p<0.0001). However, the IGRAs had significant failure rates: 15% of QFT-GIT gave indeterminate results due to failed mitogen response and 14% of T-SPOT.TB results were inconclusive, largely because of insufficient mononuclear leucocyte yields. Failure of the QFT-GIT mitogen response was associated with African ethnicity and co-morbid infections, particularly with helminths. The TST results showed poor concordance (w50%) with both IGRAs. Conclusions It is reasonable to screen using either IGRA with follow-up by the alternative if the test fails. In general, the QFT-GIT is the preferred option for nonAfrican populations but the T-SPOT.TB is recommended when there are epidemiological and/or clinical high risk factors for TB infection. However, both IGRAs have methodological and performance characteristics that limit their usefulness in refugee children, highlighting the need for continued development of screening strategies.

Background Indeterminate results are a recognised limitation of interferon - γ release assays (IGRA) in the diagnosis of latent tuberculosis (TB) infection (LTBI) and TB disease, especially in children. We investigated whether age and common co-morbidities were associated with IGRA performance in an unselected cohort of resettled refugees. Methods A retrospective cross-sectional study of refugees presenting for their post-resettlement health assessment during 2006 and 2007. Refugees were investigated for prevalent infectious diseases, including TB, and for common nutritional deficiencies and haematological abnormalities as part of standard clinical screening protocols. Tuberculosis screening was performed by IGRA; QuantiFERON-TB Gold in 2006 and QuantiFERON-TBGold In-Tube in 2007. Results Complete data were available on 1130 refugees, of whom 573 (51%) were children less than 17 years and 1041 (92%) were from sub-Saharan Africa. All individuals were HIV negative. A definitive IGRA result was obtained in 1004 (89%) refugees, 264 (26%) of which were positive; 256 (97%) had LTBI and 8 (3%) had TB disease. An indeterminate IGRA result was obtained in 126 (11%) refugees (all failed positive mitogen control). In multivariate analysis, younger age (linear OR  = 0.93 [95% CI 0.91–0.95], P <0.001), iron deficiency anaemia (2.69 [1.51–4.80], P = 0.001), malaria infection (3.04 [1.51–6.09], P = 0.002), and helminth infection (2.26 [1.48–3.46], P<0.001), but not vitamin D deficiency or insufficiency, were associated with an indeterminate IGRA result. Conclusions Younger age and a number of common co-morbidities are significantly and independently associated with indeterminate IGRA results in resettled predominantly African refugees.

In 2009, the Australasian Society of Infectious Diseases published guidelines on the post-arrival health assessment of recently arrived refugees. Since then, the number of refugees and asylum seekers reaching Australia has increased substantially (17 555 refugees in 2015-16) and the countries of origin have changed. These groups are likely to have had poor access to health care pre-arrival and, consequently, are at risk of a range of chronic and infectious diseases. We established an advisory group that included infectious diseases physicians, general practitioners, public health specialists, paediatricians and refugee health nurses to update the 2009 guidelines.Main recommendations: All people from refugee-like backgrounds, including children, should be offered a tailored comprehensive health assessment and management plan, ideally within 1 month of arrival in Australia. This can be offered at any time if initial contact with a GP or clinic is delayed. Recommended screening depends on history, examination and previous investigations, and is tailored based on age, gender, countries of origin and transit and risk profile. The full version of the guidelines is available at http://www.asid.net.au/documents/item/1225.Changes in management as a result of this guideline: These guidelines apply to all people from refugee-like backgrounds, including asylum seekers. They provide more information about non-communicable diseases and consider Asia and the Middle East as regions of origin as well as Africa. Key changes include an emphasis on person-centred care; risk-based rather than universal screening for hepatitis C virus, malaria, schistosomiasis and sexually transmissible infections; updated immunisation guidelines; and new recommendations for other problems, such as nutritional deficiencies, women's health and mental health.

Purpose – The purpose of this paper is to measure the levels of psychological distress in adults entering Western Australia (WA) as refugees through the Australian Humanitarian Programme. To determine if the introduction of mental health screening instruments impacts on the level of referrals for further psychological/psychiatric assessment and treatment. Design/methodology/approach – Participants were 300 consecutive consenting refugee adults attending the Humanitarian Entrant Health Service in Perth, WA. This service is government funded for the general health screening of refugees. The Kessler-10 (K10) and the World Health Organisation’s post-traumatic stress disorder (PTSD) screener were the principal outcome measures used. Findings – Refugees had a high rate of current probable PTSD (17.2 per cent) as measured with the PTSD screener and mean K10 scores were significantly higher than general population norms. The K10 showed high accuracy for discriminating those with or without probable PTSD. Being married and having more children increased the risk of probable PTSD. In regard to region of origin, refugees from Western and Southern Asia had significantly higher scores on both screeners followed by those from Africa with those from South-Eastern Asia having the lowest scores. Referral rate for psychiatric/psychological treatment was 18 per cent compared to 4.2 per cent in the year prior to the study. Practical implications – This study demonstrates increased psychological distress including a high rate of probable PTSD in a recently arrived multi-ethnic refugee population and also demonstrates significant variations based on region of origin. In addition, it supports the feasibility of using brief screening instruments to improve identification and referral of refugees with significant psychological distress in the context of a comprehensive general medical review. Originality/value – This was an Australian study conducted in a non-psychiatric setting. The outcomes of this study pertain to refugee mental health assessed in a general health setting. The implications of the study findings are of far reaching relevance, inclusive of primary care doctors and general physicians as well as mental health clinicians. In particular the authors note that the findings of this study are to the authors’ knowledge unique in the refugee mental health literature as the participants are recently arrived refugees from diverse ethnic groups.